Point-of-care CD4 testing to inform selection of antiretroviral medications in South African antenatal clinics: A cost-effectiveness analysis

Andrea L. Ciaranello, Landon Myer, Kathleen Kelly, Sarah Christensen, Kristen Daskilewicz, Katie Doherty, Linda Gail Bekker, Taige Hou, Robin Wood, Jordan A. Francke, Kara Wools-Kaloustian, Kenneth A. Freedberg, Rochelle P. Walensky

Research output: Contribution to journalArticle

9 Scopus citations

Abstract

Background Many prevention of mother-to-child HIV transmission (PMTCT) programs currently prioritize antiretroviral therapy (ART) for women with advanced HIV. Point-of-care (POC) CD4 assays may expedite the selection of three-drug ART instead of zidovudine, but are costlier than traditional laboratory assays. Methods We used validated models of HIV infection to simulate pregnant, HIV-infected women (mean age 26 years, gestational age 26 weeks) in a general antenatal clinic in South Africa, and their infants. We examined two strategies for CD4 testing after HIV diagnosis: laboratory (test rate: 96%, result-return rate: 87%, cost: $14) and POC (test rate: 99%, result-return rate: 95%, cost: $26). We modeled South African PMTCT guidelines during the study period (WHO "Option A"): antenatal zidovudine (CD4 ≤350/μL) or ART (CD4>350/μL). Outcomes included MTCT risk at weaning (age 6 months), maternal and pediatric life expectancy (LE), maternal and pediatric lifetime healthcare costs (2013 USD), and cost-effectiveness ($/lifeyear saved). Results In the base case, laboratory led to projected MTCT risks of 5.7%, undiscounted pediatric LE of 53.2 years, and undiscounted PMTCT plus pediatric lifetime costs of $1,070/infant. POC led to lower modeled MTCT risk (5.3%), greater pediatric LE (53.4 years) and lower PMTCT plus pediatric lifetime costs ($1,040/infant). Maternal outcomes following laboratory were similar to POC (LE: 21.2 years; lifetime costs: $23,860/person). Compared to laboratory, POC improved clinical outcomes and reduced healthcare costs. Conclusions In antenatal clinics implementing Option A, the higher initial cost of a one-time POC CD4 assay will be offset by cost-savings from prevention of pediatric HIV infection.

Original languageEnglish (US)
Article number0117751
JournalPLoS One
Volume10
Issue number3
DOIs
StatePublished - Mar 1 2015

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

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    Ciaranello, A. L., Myer, L., Kelly, K., Christensen, S., Daskilewicz, K., Doherty, K., Bekker, L. G., Hou, T., Wood, R., Francke, J. A., Wools-Kaloustian, K., Freedberg, K. A., & Walensky, R. P. (2015). Point-of-care CD4 testing to inform selection of antiretroviral medications in South African antenatal clinics: A cost-effectiveness analysis. PLoS One, 10(3), [0117751]. https://doi.org/10.1371/journal.pone.0117751